title: Twenty-five year follow-up of childhood Wilms tumor: a report from the Childhood Cancer Survivor Study.
abstract: BACKGROUND
  Treatment cures over 90% of children with Wilms tumor (WT) who subsequently risk late morbidity and mortality. This study describes the 25-year outcomes of 5-year WT survivors in the Childhood Cancer Survivor Study (CCSS).
  
  
  METHODS
  The CCSS, a multi-institutional retrospective cohort study, assessed WT survivors (N = 1,256), diagnosed 1970-1986, for chronic health conditions, health status, health care utilization, socioeconomic status, subsequent malignant neoplasms (SMNs), and mortality compared to the US population and a sibling cohort (N = 4,023).
  
  
  RESULTS
  The cumulative incidence of all and severe chronic health conditions was 65.4% and 24.2% at 25 years. Hazard ratios (HR) were 2.0, 95% confidence interval (CI) 1.8-2.3 for grades 1-4 and 4.7, 95%CI 3.6-6.1 for grades 3 and 4, compared to sibling group. WT survivors reported more adverse general health status than the sibling group (prevalence ratio [PR] 1.7; 95%CI 1.2-2.4), but mental health status, socioeconomic outcome, and health care utilization were similar. The cumulative incidence of SMN was 3.0% (95%CI 1.9-4.0%) and of mortality was 6.1% (95%CI 4.7-7.4%). Radiation exposure increased the likelihood of congestive heart failure (CHF) (no doxorubicin-HR 6.6; 95%CI 1.6-28.3; doxorubicin ≤ 250 mg/m(2) -HR 13.0; 95%CI 1.9-89.7; doxorubicin >250 mg/m(2) -HR 18.3; 95%CI 3.8-88.2), SMN (standardized incidence ratio [SIR] 9.0; 95%CI 3.9-17.7 with and 4.9; 95%CI 1.8-10.6 without doxorubicin) and death.
  
  
  CONCLUSIONS
  Long-term survivors of WT treated from 1970 to 1986 are at increased risk of treatment related morbidity and mortality 25 years from diagnosis.
authors.affiliation: Department of Pediatrics, University of Southern California, Miller Children's Hospital, Long Beach, California 90806, USA. atermuhlen@chla.usc.edu
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Termuhlen
authors.forename: Jean M
authors.initials: JM
authors.lastname: Tersak
authors.forename: Qi
authors.initials: Q
authors.lastname: Liu
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yasui
authors.forename: Marilyn
authors.initials: M
authors.lastname: Stovall
authors.forename: Rita
authors.initials: R
authors.lastname: Weathers
authors.forename: Melvin
authors.initials: M
authors.lastname: Deutsch
authors.forename: Charles A
authors.initials: CA
authors.lastname: Sklar
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Oeffinger
authors.forename: Greg
authors.initials: G
authors.lastname: Armstrong
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Green
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000970:Antineoplastic Agents / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007680:Kidney Neoplasms / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects; D035781:Siblings; D016019:Survival Analysis; D017741:Survivors / Q000706:statistics & numerical data*; D009396:Wilms Tumor / Q000150:complications* / Q000401:mortality; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents